Management of Heart Failure (HF)



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Lec.8 PHARMACOLOGY College of Dentistry

Dr. Zainab Ghalib Al-Jassim Baghdad University


Management of Heart Failure
Heart failure (HF), often referred to as congestive heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs.  
Signs and symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night. A limited ability to exercise is also a common feature.
Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause. These cause heart failure by changing either the structure or the functioning of the heart.
Classification: there are two types of classifications either to Systolic and Diastolic heart failure or to Left-sided and right-sided heart failure.

First classification→



  1. Systolic (or squeezing) heart failure

  • It means decreased pumping function of the heart.

  • Systolic heart failure typically affects the left side of the heart. This is the side that pumps blood to the body.

  1. Diastolic (or relaxation) heart failure

  • Is a decline in performance of one (usually the left) or both ventricles during diastole. Diastole is the cardiac cycle phase during which the heart is relaxing and filling with incoming blood.

  • Involves a thickened and stiff heart muscle.

  • As a result, the heart does not fill with blood properly.

Second classification→



  • Left-sided heart failure: fluid built up in the lung.

  • Right-sided heart failure: fluid built up in the body (feet, leg, abdomen…)




Compensatory Mechanisms of heart failure

  • Renin-angiotensin-aldosterone system

  • Sympathetic nervous system

  • Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).


Diagnosis

  • A Key Indicator for Diagnosing Heart Failure is Ejection Fraction (EF)

Ejection Fraction (EF) is the percentage of blood that is pumped out of your heart during each beat.



  • Medical history

  • Physical examination

  • Tests

    • Chest X-ray

    • Blood tests

    • Electrical tracing of heart (Electrocardiogram or “ECG”)

    • Ultrasound of heart (Echocardiogram or “Echo”)

    • X-ray of the inside of blood vessels (Angiogram)

Treatment goal

The goals of treatment for people with heart failure are the prolongation of life, the prevention of acute decompensation and the reduction of symptoms, allowing for greater activity.

TREATMENT

1- Angiotensin-converting enzyme inhibitors (ACE-I) or Angiotensin receptor blockers (ARBS)

Digitalis_(digoxin)___5-Diuretics'>2-Beta-blocker (BB)

3-Vasodilators

4-Digitalis (digoxin)

5-Diuretics

1- Angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) : First-line therapy for people with heart failure due to relaxation of blood vessels that reduces both preload and afterload on the heart.

2-Beta-blocker: also form part of the first line of treatment. They reduces the action of catecholamines and slows the heart rate. Bisoprolol, carvedilol, and metoprolol have been shown to reduce mortality rate.

3-Vasodilators: In people who are intolerant of ACE-I and ARBs or who have significant kidney dysfunction, the use of combined hydralazine and a long-acting nitrate, such as isosorbide dinitrate, are an effective alternative. This regimen has been shown to reduce mortality in people with moderate heart failure.



4-Digitalis (digoxin): Second-line drug, It is used to increase cardiac contractility (it is a positive inotrope).

5-Diuretics have been a mainstay of therapy for treatment of fluid accumulation, and include diuretics classes such as loop diuretics, thiazide-like diuretic, and potassium-sparing diuretic. They filter sodium and excess fluid from the blood to reduce the heart’s workload.
Digitalis

Digitalis is the genus name for the family of plants that provide most of the medically useful cardiac glycosides, eg, digoxin.  It is used to increase cardiac contractility (it is a positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in the irregular (and often fast) atrial fibrillation. Digitalis is hence often prescribed for patients in atrial fibrillation, especially if they have been diagnosed with congestive heart failure.





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